Application value of enhanced recovery after surgery in the perioperative period of biliary surgery / 中华消化外科杂志

ABSTRACT

Objective To explore the clinical value of enhanced recovery after surgery (ERAS) in the perioperative period of biliary surgery.Methods The prospective study was adopted.The clinical data of 800 patients diagnosed as benign biliary tract diseases who were admitted to the Cangzhou's Central Hospital from March 2011 to January 2015 were collected.Patients were randomly divided into the case and control groups by random sequence method.The patients of case group received the ERAS management and patients of the control group received traditional perioperative management.(1) Stress state evaluationthe insulin resistance (IR) index and level of serum C-reactive protein (CRP) were calculated.(2) Levels of inflammatory cytokineslevels of IL-6 and TNF-α in the 2 groups were detected by enzyme-linked immunosorbent assay (ELISA).(3)Nutritional statuslevel of serum prealbumin (PA) was detected.(4) Postoperative statustime to anal exsufflation,time of defecation,duration of hospital stay and treatment expenses were recorded.(5) Postoperative complications were observed.Measurement data with normal distribution were represented as x ± s and comparison between groups was analyzed using t test.Repeated measurement data were analyzed by the repeated measures ANOVA.Count data were represented as ratio and analyzed using the chi-square test.Results The 800 patients were screened for eligibility,including 400 in each group.(1) Stress state evaluationthe levels of IR and CRP from pre-operation to 7 days after operation were from 3.8 ± 0.8 to 3.7 ± 0.7 and from (18 ± 5) μg/L to (27 ±8) μg/L in the case group,from 3.9 ±0.9 to 3.8 ±1.0 and from (18 ±5) μg/L to (38 ±9) μg/L in the control group,respectively,with statistically significant differences in the changing trends (F =12.38,17.85,P ＜0.05).(2) Comparisons of levels of inflammatory cytokineslevels of IL-6 and TNF-α from pre-operation to 7 days after operation were from (9.3 ± 3.1) ng/L to (12.5 ± 2.8) ng/L and from (10.2 ± 3.5) ng/L to (12.8 ±3.3)ng/L in the case group,from (8.9 ±3.3)ng/L to (17.3 ±6.5)ng/L and from (9.9 ±2.8) ng/L to (14.3 ±4.2)ng/L in the control group,with statistically significant differences in the changing trends (F =19.93,15.74,P ＜ 0.05).(3) Comparison of nutritional statuslevel of PA from pre-operation to 7 days after operation was from (335 ± 53)mg/L to (332 ±50)mg/L in the case group and from (330 ± 49)mg/L to (331 ± 45)mg/L in the control group,with a statistically significant difference in the changing trends (F =4.46,P ＜ 0.05).(4)Comparisons of postoperative statustime to anal exsufflation,time of defecation,duration of hospital stay and treatment expenses were (30 ± 10)hours,(51 ± 13) hours,(7.7 ± 2.5) days,(10.2 ±2.3) × 103 yuan in the case group and (54 ± 8) hours,(70 ± 16) hours,(15.4 ± 3.1) days,(15.6 ± 4.7) × 103 yuan in the control group,with statistically significant differences (t =37.73,18.62,38.67,20.64,P ＜0.05).(5) Comparisons of postoperative complicationsincidence of complications was 15.00％ (60/400)in the case group and 22.50％(90/400) in the control group,and the numbers of patients with incision infection,nausea and vomiting,abdominal infection,intra-abdominal infection,urinary tract infection,intro-abdominal hemorrhage and bile leakage were 23,15,8,5,4,3,2 in the case group and 30,20,13,10,7,5,5 in the control group,respectively,showing statistically significant differences in the incidence of complications (x2=7.39,P ＜ 0.05).Conclusion ERAS management in the perioperative period of biliary surgery is beneficial to postoperative recovery of patients,and it can also relieve postoperative stress state and inflammatory response,reduce the duration of hospital stay,treatment expenses and incidence of postoperative complications.